Lillian Gilley is a 43 year-old-old female who was seen in my office on May 18, 2010, with a complaint of left arm stiffness and feeling cold. Initially, her left hand was cold, but she gradually developed tingling in her fingers. She was not using the arm and was having difficulty using her hand. At rest, her hand curled upward and inward. Her legs felt weak, primarily around her knees, and her gait was unsteady. She noticed difficulty changing from sitting to standing or getting up from a crouched position. Her spouse had noticed occasional limping. She has a history of migraine headaches and described experiencing pressure headaches in the back of her neck and around her head. Her symptoms were progressively worsening.
Her primary care physician referred her to neurologist, Larry Seiden, M.D. Dr. Seiden ordered an MRI of the brain which showed a large tumor spanning the foramen mangnum, the opening of the base of the skull where the brainstem exits and transitions to the spinal cord.
When I reviewed the MRI, I was surprised that Lillian was able to walk at all. The normal opening of the foramen magnum which would normally be about 30 mm in size (a little more than an inch) was narrowed by the tumor to only 2 to 3 mm. The brainstem compression was extreme, and the delicate nerves that operate voice and swallowing functions were badly stretched. I had a long discussion with Lillian and her husband. Tumor surgery in this location is long, tedious, and has one of the highest risks of death or disability in the spectrum of tumor operations. Lillian had her tumor surgery on June 3 at Piedmont. I completed the tumor exposure in about five hours, performing what is known as an extreme far lateral transcondylar approach to the skull base and upper cervical spine. The tumor removal itself was done about 3 1/2 hours later. The vertebral artery, which was embedded in the tumor, was preserved. The nerves to voice and swallowing function were preserved. Ninety-eight percent of the tumor was removed. Its base on the dural, the layer of tissue that holds the spinal fluid in, will be treated with a focal radiation dose by Fred Schwaibold, M.D., to prevent the tumor from growing back.
Lillian spent one night in the neuro ICU, and then was up on her feet the day after surgery. She was out of the hospital and back home three days after surgery. She rapidly experienced relief of her symptoms, and had no surgical complications.
Editor's Note: Today, Lillian is an active, happy wife and mother of two young children, ages two and three. Her initial symptoms of cold hands and numbness in her fingertips led her to seek medical attention. She chose to move forward with the surgery because her symptoms were becoming progressively worse. "I did it for my husband and my children" says Mrs. Gilley. "I needed to live and be a great wife and mother."
Following her surgery, she is symptom free. While she was anxious prior to the surgery, she says, It made my life 100 percent better. It's the best thing I could have ever done.